Rheumatoid arthritis-associated spinal neuroarthropathy with double-level isthmic spondylolisthesis.

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Rheumatoid arthritis-associated spinal neuroarthropathy with double-level isthmic spondylolisthesis.

Eur Spine J. 2017 Jul 28;:

Authors: Kim SI, Kim YH, Lee JW, Kang WW, Ha KY

Abstract
INTRODUCTION: To the best of our knowledge, there has been no report regarding rheumatoid arthritis associated with spinal neuroarthropathy and combined double-level isthmic spondylolisthesis. Here, we report a rare case of spinal neuroarthropathy with double-level isthmic spondylolisthesis in a rheumatoid arthritis (RA) patient. A 56-year-old female patient under medical treatment for RA during the last 13 years presented aggravating radiating pain to her right lower extremity and a limping gait developed 4 months ago. The disease activity of RA had remained low for a long time. Serial radiographs during last 8-year follow-up showed progressive dislocation at L4-L5 and L5-S1 with double-level isthmic spondylolisthesis and severe destructive status at the last follow-up. The patient underwent decompression and circumferential fusion with sacropelvic fixation and acceptable reduction was obtained.
CONCLUSION: A RA patient with double-level isthmic spondylolisthesis showed a progressive destructive lesion. In addition to clinical presentations, the imaging findings were very similar to ones of spinal neuroarthropathy. The authors conclude that this Grand Round case probably had SNA secondary to RA and that this, combined with two-level isthmic spondylolisthesis, resulted in her rapidly progressing destructive lumbar lesion.

PMID: 28755075 [PubMed – as supplied by publisher]

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Autologous bone marrow concentrate intradiscal injection for the treatment of degenerative disc disease with three-year follow-up.

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Autologous bone marrow concentrate intradiscal injection for the treatment of degenerative disc disease with three-year follow-up.

Int Orthop. 2017 Jul 26;:

Authors: Pettine KA, Suzuki RK, Sand TT, Murphy MB

Abstract
PURPOSE: The purpose of this study is to assess safety and feasibility of intradiscal bone marrow concentrate (BMC) injections to treat low back discogenic pain as an alternative to surgery with three year minimum follow-up.
METHODS: A total of 26 patients suffering from degenerative disc disease and candidates for spinal fusion or total disc replacement surgery were injected with 2 ml autologous BMC into the nucleus pulposus of treated lumbar discs. A sample aliquot of BMC was characterized by flow cytometry and CFU-F assay to determine progenitor cell content. Improvement in pain and disability scores and 12 month post-injection MRI were compared to patient demographics and BMC cellularity.
RESULTS: After 36 months, only six patients progressed to surgery. The remaining 20 patients reported average ODI and VAS improvements from 56.7 ± 3.6 and 82.1 ± 2.6 at baseline to 17.5 ± 3.2 and 21.9 ± 4.4 after 36 months, respectively. One year MRI indicated 40% of patients improved one modified Pfirrmann grade and no patient worsened radiographically. Cellular analysis showed an average of 121 million total nucleated cells per ml, average CFU-F of 2713 per ml, and average CD34+ of 1.82 million per ml in the BMC. Patients with greater concentrations of CFU-F (>2000 per ml) and CD34+ cells (>2 million per ml) in BMC tended to have significantly better clinical improvement.
CONCLUSIONS: There were no adverse events related to marrow aspiration or injection, and this study provides evidence of safety and feasibility of intradiscal BMC therapy. Patient improvement and satisfaction with this surgical alternative supports further study of the therapy.

PMID: 28748380 [PubMed – as supplied by publisher]

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Comparison of Posterior Lumbar Interbody Fusion Versus Posterolateral Fusion for the Treatment of Isthmic Spondylolisthesis.

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Comparison of Posterior Lumbar Interbody Fusion Versus Posterolateral Fusion for the Treatment of Isthmic Spondylolisthesis.
Clin Spine Surg. 2017 Aug;30(7):E915-E922
Authors: Luo J, Cao K, Yu T, L…

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Intraoperative navigation for accurate midline placement of anterior lumbar interbody fusion and total disc replacement prosthesis.

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Intraoperative navigation for accurate midline placement of anterior lumbar interbody fusion and total disc replacement prosthesis.
J Spine Surg. 2017 Jun;3(2):228-232
Authors: Phan K, Xu J, Maharaj…

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Different operative findings of cases predicted to be symptomatic discal pseudocysts after percutaneous endoscopic lumbar discectomy.

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Different operative findings of cases predicted to be symptomatic discal pseudocysts after percutaneous endoscopic lumbar discectomy.
J Spine Surg. 2017 Jun;3(2):233-237
Authors: Shiboi R, Oshima Y,…

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Titanium vs. polyetheretherketone (PEEK) interbody fusion: Meta-analysis and review of the literature.

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J Clin Neurosci. 2017 Jul 20;:
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The available evidence on demineralised bone matrix in trauma and orthopaedic surgery: A systematic review.

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Bone Joint Res. 2017 Jul;6(7):423-432
Authors: van der Stok J, Hartholt KA, Schoenmakers D…

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Endoscope assisted Abscess drainage secondary to endoscope-assisted TLIF – 1 year follow up.

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World Neurosurg. 2017 Jul 19;:
Authors: Madhavan K, Burks SS, Chieng LO, Veeravagu A, Wang MY
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Radiation dose reduction in thoracic and lumbar spine instrumentation using navigation based on an intraoperative cone beam CT imaging system: a prospective randomized clinical trial.

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Transforaminal Percutaneous Endoscopic Discectomy and Foraminoplasty after Lumbar Spinal Fusion Surgery.

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Transforaminal Percutaneous Endoscopic Discectomy and Foraminoplasty after Lumbar Spinal Fusion Surgery.

Pain Physician. 2017 Jul;20(5):E647-E651

Authors: Wu JJ, Chen HZ, Zheng C

Abstract
BACKGROUND: The most common causes of pain following lumbar spinal fusions are residual herniation, or foraminal fibrosis and foraminal stenosis that is ignored, untreated, or undertreated. The original surgeon may advise his patient that nothing more can be done in his opinion that the nerve was visually decompressed by the original surgery. Post-operative imaging or electrophysiological assessment may be inadequate to explain all the reasons for residual or recurrent symptoms. Treatment of failed lumbar spinal fusions by repeat traditional open revision surgery usually incorporates more extensive decompression causing increased instability and back pain. The authors, having limited their practice to endoscopic surgery over the last 10 years, report on their experience gained during that period to relieve pain by transforaminal percutaneous endoscopic revision of lumbar spinal fusions.
OBJECTIVE: To assess the effectiveness of transforaminal percutaneous endoscopic discectomy and foraminoplasty in patients with pain after lumbar spinal fusion.
STUDY DESIGN: Retrospective study.
SETTING: Inpatient surgery center.
METHODS: Sixteen consecutive patients with pain after lumbar spinal fusions presenting with back and leg pain that had supporting imaging diagnosis of foraminal stenosis and/or residual/recurrent disc herniation, or whose pain complaint was supported by relief from diagnostic and therapeutic injections, were offered percutaneous transforaminal endoscopic discectomy and foraminoplasty over a repeat open procedure. Each patient sought consultation following a transient successful, partially successful or unsuccessful open lumbar spinal fusions treatment for disc herniation or spinal stenosis. Endoscopic foraminoplasty was also performed to either decompress the bony foramen in the case of foraminal stenosis, or to allow for endoscopic visual examination of the affected traversing and exiting nerve roots in the axilla. The average follow-up time was 30.3 months, minimum 12 months. Outcome data at each visit included MacNab criteria, visual analog scale (VAS), and Oswestry Disability Index (ODI).
RESULTS: The average leg VAS improved from 9.1 ± 2.0 to 2.0 ± 0.8 (P < 0.005). Ten patients had excellent outcomes, 5 had good outcomes, one had a fair outcome, and none had poor outcomes, according to the MacNab criteria. Fifteen of 16 patients had excellent or good outcomes, for an overall success rate of 93.7%. No patients required reoperation. There were no incidental durotomies, infections, vascular, or visceral injuries. There was one complication, a case of leg numbness caused by dorsal root ganglion injury. The numbness improved after 2 weeks. After 3 months, physical exam showed that the total area of numbness in the legs had decreased. At last follow-up, the patient had no pain, and only a few areas with numbness remained that did not affect the patient’s activities of daily living. The patient was relieved to be able to avoid open decompression.
LIMITATIONS: This is a retrospective study.
CONCLUSIONS: The transforaminal endoscopic approach is effective for patients with back or leg pain after lumbar spinal fusions due to residual/recurrent nucleus pulposus and foraminal stenosis. Failed initial index surgery may involve failure to recognize patho-anatomy in the axilla of the foramen housing the traversing and the exiting nerve. The transforaminal endoscopic approach effectively decompresses the foramen and does not further destabilize the spine needing stabilization. It also avoids going through the previous surgical site.
KEY WORDS: Full-endoscopic, foraminal stenosis, recurrent herniation, surgical treatment, fusion.

PMID: 28727709 [PubMed – in process]

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